JOB SUMMARY
This job supports leadership of the Risk Adjustment Accuracy Management (RAAM) department with a range of activities essential to RAAM’s program strategy and operational goals. Provide analytical/strategic-thinking and leadership support that enables project teams to: 1) isolate business issues; 2) design and execute analytics for studying business issues (market research, scenario planning, forecasting, market share, profitability, etc.); 3)
develop technical content (competitive intelligence, market trend analysis); 4) support development of formal recommendations to senior levels of Highmark leadership; 5) create documents (go-to-market or operational strategies, etc.) that inform critical strategic issues and decisions.
This role can be hybrid or remote. However if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, TH.
ESSENTIAL RESPONSIBILITIES
- Work with business/ market owners to identify key business issues, apply right analytical framework, develop solution and recommendations, represent findings to stakeholders and own the outcome.
- Lead the successful delivery of evolving risk adjustment initiatives and projects, driving outcomes directly aligned with RAAM's strategic plan
- Manage major strategy projects with the help of internal or external strategy consulting resources.
- Serve as subject matter expert to Strategic Operations staff and stakeholders on risk adjustment programs for Medicare Advantage, Medicaid, and ACA lines of business.
- Provide periodic informal work guidance/direction to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project basis.
- Develop analytical frameworks, approach and methodology best practices to analyze strategy issues.
- Other duties as assigned or requested.
EDUCATION
Required
- Masters Degree in Business, Healthcare, Economics or related degree
- 2 years of post-grad experience with strategy / management consulting firms (such as McKinsey, Boston Consulting Group, Booz & Company, Accenture (strategy Practice) or Deloitte (Strategy practice) ) or internal strategy groups of healthcare companies (such as Aetna, United Health Group, WellPoint, GE, )
- 6 years of related experience in Business or Healthcare
Substitution
- Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree
Preferred
- Extensive knowledge of Health Insurance and/or Provider operations
- Experience in operational improvement
Extensive knowledge of government risk adjustment models, including CMS-HCC, HHS-HCC, and/or CDPS models
- Extensive experience in implementing and managing provider-facing and/or patient-facing programs for the purposes of ensuring complete and accurate risk documentation
- Through knowledge of membership, rates, financial, economic and competitive data
LICENSES or CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields
- Strong PC application Skills (MS Office including PowerPoint and Excel)
- Knowledge of healthcare industry trends and challenges
- Strong critical thinking skills
- Good communication and presentation skills
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based or Remote
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Never
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Never
Lifting: 25 to 50 pounds
Never
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$108,600.00Pay Range Maximum:
$180,600.00Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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For accommodation requests, please contact HR Services Online at [email protected]
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Skills Required
- Master’s degree in Business, Healthcare, Economics, or a related field
- Two years of post-graduate experience with a strategy or management consulting firm, or an internal strategy group of a healthcare company
- Six years of related experience in business or healthcare
- Bachelor’s degree and three years of relevant progressive strategic experience may substitute for the Master’s degree
- Extensive knowledge of health insurance and/or provider operations
- Experience in operational improvement
- Extensive knowledge of government risk adjustment models, including CMS-HCC, HHS-HCC, and/or CDPS
- Extensive experience implementing and managing provider-facing and/or patient-facing programs to ensure complete and accurate risk documentation
- Thorough knowledge of membership, rates, financial, economic, and competitive data
- Strong Microsoft Office application skills, including PowerPoint and Excel
- Knowledge of healthcare industry trends and challenges
- Strong critical-thinking skills
- Good communication and presentation skills
Highmark Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Highmark Health and has not been reviewed or approved by Highmark Health.
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Healthcare Strength — Medical, prescription, dental, and vision coverage are emphasized alongside 100% coverage for preventive exams, with onsite pharmacy access and fitness center availability at major campuses.
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Retirement Support — An employer‑sponsored 401(k) with a company match is highlighted, with AHN materials illustrating a 100% match on the first 4% plus an additional 1% employer contribution as an example within the enterprise.
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Wellbeing & Lifestyle Benefits — Wellness programs include stress‑management classes, health coaching, incentives for healthy activities, team‑member discounts, and volunteer incentives, with paid volunteer time also noted in the overall package.
Highmark Health Insights
What We Do
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 40,000 people who serve millions of Americans across the country, is the second largest integrated health care delivery and financing network in the nation based on revenue. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to nearly 5 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, more than 2,800 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia and New York, with customers in all 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. Our companies cover a diversified spectrum of essential health-related needs, including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative technology solutions. We’re also proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
